| NPI | 1255012027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: AZ LAMFT-10754) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IL 208.000999) |
| 106H00000X Marriage & Family Therapist (Licence: CO MFTC.0014369) | |
| Enumeration Date | 2023-07-26 |
| Last Update Date | 2023-07-26 |